Jack’s Health Part D: Heart Failure
When the nurse working the morning shift comes by to see Jack, she notices that there is increased swelling of the ankles, feet and legs and his lower extremities were cool to the touch.
When attempting to wake Jack, the nurse notices that he’s extremely tired and would not open his eyes. Jack responds to her questions in a very slow pace with a sluggish tone. He would further comment to the nurse that he does not know where he is and would like to see his wife.
An Overview of Heart Failure
What is heart failure?
A condition caused by the heart not functioning as it should or a problem with its structure. It can happen if the heart is too weak or too stiff, or both. This can lead to different comorbidities such as fatigue, swelling in the legs and abdomen and shortness of breath which can be from fluid in the lungs
What caused Jack’s Heart Failure?
Diabetes
- Over time, high blood sugar can damage blood vessels and the nerves that control your heart.
- People with diabetes are also more likely to have other conditions that raise the risk for heart disease.
Atrial Fibrillation
- Irregular, fast heartbeat.
- leads to ineffective pumping of the blood which – especially if not controlled – may weaken the heart.
Signs & Symptoms
When the heart doesn’t pump well and congestion occurs, the following symptoms may appear:
- increased shortness of breath, especially when lying flat
- sudden gain of more than 1.5 kg (3 pounds) over 1 to 2 days, or 2.5 kg (5 pounds) in a single week
- bloating or feeling full all the time
- cough or cold symptoms that last for longer than a week
- tiredness, loss of energy or extreme tiredness
- loss of or change in appetite
- increased swelling of the ankles, feet, legs, sacrum (base of the spine) or abdomen (stomach area)
- increased urination at night
- cool extremities
- new experience of cognitive impairment (confusion and trouble thinking clearly)
Which of these symptoms does Jack experience?
Diagnosing Jack with Heart Failure
The doctor asked Jack for his medical history, performed an examination, and took some tests to determine if heart failure was present and how it should be treated and managed. Doctors may use several tests and procedures such as:
- ECHO
- Stress test
- Coronary angiogram
- Lethargy
- Blood test & brain natriuretic peptide (BNP)
- NT-proBNP
- ECG
- Chest X-ray
Treating Heart Failure Medications
A combination of medications was administered to Jack:
ACE inhibitors
- Relaxes blood vessels
- Decreases blood volume
Beta blockers
- Manages heart rhythm
Diuretics
- Increases urine production
Preventing Heart Failure
Prevention of heart failure mainly lies in lifestyle management
- Healthy diet: Avoiding intake of fatty and salty foods greatly improves the cardiovascular health of an individual.
- Cardiovascular exercises: Any activity that will increase heart rate and respiration. Vigorous activity raises oxygen and blood flow throughout the body.
- Smoking cessation: Nicotine causes vasoconstriction that increases the pressure along the vessels.
Assessing Jack with ISBAR
What is ISBAR?
Identify, Situation, Background, Assessment, Recommendation
The ISBAR (situation, background, assessment and recommendation) tool is provided below to aid in facilitating and strengthening communication between nurses and prescribers throughout the implementation of this quality improvement initiative.
| Identity | Who are you? Where are you?
Patient’s name, age, gender and department |
| Situation | What is the problem/reason for contact?
Describe, ABCDE, test results, measured values |
| Background | If it’s urgent and/or you are concerned -speak up. Brief and relevant case history
Diagnosis, date, previous illness of significance, problems, treatment/intervention, allergies |
| Assessment | Assessment of situation and background
Is patient stable? What is the reason for patients condition? |
| Recommendation | Request specific advice and interventions and clarify expectations
What interventions do you recommend? |
After his assessment, the nurses overseeing Jack’s care during hospitalization, implement interventions to:
- Improve myocardial contractility/systemic perfusion.
- Reduce fluid volume overload.
- Prevent complications.
- Provide information about disease/prognosis, therapy needs, and prevention of recurrences.
Nursing Interventions
Jack’s nurses are focused on managing his activities and fluid intake that includes:
- Promoting activity tolerance. A total of 30 minutes of physical activity every day should be encouraged, and the nurse and the physician should collaborate to develop a schedule that promotes pacing and prioritization of activities.
- Managing fluid volume. The patient’s fluid status should be monitored closely, auscultating the lungs, monitoring daily body weight, and assisting the patient to adhere to a low sodium diet.
- Controlling anxiety. When the patient exhibits anxiety, the nurse should promote physical comfort and provide psychological support, and begin teaching ways to control anxiety and avoid anxiety-provoking situations.
- Minimizing powerlessness. Encourage the patient to verbalize their concerns and provide the patient with decision-making opportunities.
Cardiac Rehabilitation
- There are multiple Cardiac Rehabilitation Centers across the GTA to support clients with progressive cardiac disorders to maintain their standard or living and recovery from major cardiovascular incidents
- Jack has had difficult transition in completing his physical activity, regulating his diet and taking his medications as directed
Cardiac Rehabilitation Network of Ontario
Main Goals of Cardiac Rehabilitation
Stress Management
Health Education
- On the risk factors for Heart Disease and how to manage their symptoms
- Waist Circumference (40 inches males and 35 inches females)
- High LDL Cholesterol Levels
- Genetics (non-modifiable)
- Gender (non-modifiable)
- Smoking, Physical Activity, and Diet (modifiable)
Exercise
- Anywhere from walking to playing sports
Nutritious Diet
- Low in sodium, cholesterol, high in fiber, and low in sugars and fats
Monitor weight
- Especially with CHF clients
Medication Review
Counselling
- For client struggling with anxiety, depression, poor sleep, or stress following their cardiac event/ procedure
Q&A
Based on his health history would Jack qualify for cardiac rehabilitation at this time, if so why?
Yes Jack would qualify! Cardiac Rehabilitation requires clients to be motivated to participate in rehabilitation as this is a long term process that may require multiple visits each week for recovery.
